Provider Demographics
NPI:1124566245
Name:TARA MCKELVY PSYCHOLOGY PLLC
Entity Type:Organization
Organization Name:TARA MCKELVY PSYCHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKELVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-891-6626
Mailing Address - Street 1:12801 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 1730
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-1716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12801 N CENTRAL EXPY
Practice Address - Street 2:SUITE 1730
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1716
Practice Address - Country:US
Practice Address - Phone:817-891-6626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37380251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health